dody firmanda 2008 - amrin 7 nov 2008 program pengendalian resistensi antimikroba di rs
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Peran Komite Medikdalam
PelaksanaanProgram Pengendalian Resistensi Antimikroba
Dr. Dody Firmanda, Sp.A, MAKetua Komite Medik
RSUP Fatmawati, Jakarta
http://www.esnips.com/web/komitemedik
Disampaikan pada pertemuan Amrin (Antimicrobial Resistance of Indonesia)Diselenggarakan oleh Direktorat Bina Medik Spesialistik Depkes RI di HotelHorison Bekasi 6 – 8 November 2008.
Gambar 1. Konsep dan Filosofi Komite Medik RS: Etika, Mutu dan Evidence-basedMedicine (EBM)
ClinicalLeadership
(untuk RS pendidikan)
KOMITE MEDIK: SISTEM CLINICAL GOVERNANCE, PATIENT SAFETY & CP
/ Adverse Events
SurveilansInfeksi
Nosokomial
High ImpactInterventions
Process:Implementation
of Patient Safety
1
2
3
4
5
Peran Komite Medik:Menegakkan Etik dan Mutu Profesi
Program Pengendalian Resistensi Antimikroba
1. Audit Medis2. Clinical Risks
Management3. Safety
1. DaftarFormularium RS
2. SPM/SPO3. CP: Penyakit
Infeksi & Tropis4. Surveilans
InfeksiNosokomial
5. High ImpactInterventions
1. Seleksi Antibiotik2. Penggunaan Antibiotik3. Penyebaran Mikroba
SurveilansInfeksi
Nosokomial
High ImpactInterventions
Program Pengendalian Resistensi Antimikroba1. Seleksi2. Penggunaaan3. Penyebaran
1. Daftar Formularium2. SPM/SPO
1. Surveilans2. High Impact Interventions1. Audit Medis
2. Clinical RisksManagement
3. PatientSafety
Clinical Pathways:Penyakit Infeksi dan Tropis
Terintegrasi secara ko-ordinasi dan ko-operasi
“span& spin ofcontrol ”
“Patched-in”“Patched-in”
MILIK KOMITE MEDIK RSUP FATMAWATI
2005 -2008
Pola Kuman 2005
Jenis Kuman Menurut Bahan RSUP Fatmawati JakartaJanuari - Desember 2005
Jenis Kuman Menurut RuangRSUP Fatmawati JakartaJanuari - Desember 2005
Gram negatif80.8%
Gram positif19.2%
Pseudo mo nas sp.21.2%
P.mirabilis3.6%
S.liquifaciens2.9%
P.aeruginosa2.4%
E.gregov iae2.1%
K.ozaenae1.8%
A.hinshawii1.0%S.enteritidis
1.1%
S.typhi1.3%
S.rubidiae1.0%
0.8%
C.amalunatycus0.2%
P.stuart ii0.2%
E.co li21.4%
E.aerogenes19.9%
K.pneumoniae9.5%
S.marcesens9.2%
S.aureus
17.0%
S.epidermidis
55.1%
β-haemolyt icus
23.4%
S.saprophyt icus
3.4%
Pola Kuman 2006
Jenis Kuman Menurut Bahan RSUP Fatmawati JakartaJanuari - Desember 2006
Jenis Kuman Menurut Ruang RSUP Fatmawati JakartaJanuari - Desember 2006
Pola Kuman 2007
GRAM NEGATIF
E .aer ogenes
19.5%
S. l i qui f ac i ens
7. 3%P.mi r abi l i s
4.6%
S.mar cesens
4. 1%
K .ozaenae
3.6%
P.aer ugi nosa
2. 6%
E.cl oac ae
1. 5%
E.gr egov i ae
0.9%
S.typhi
1. 2%
S. r ubi di ae
0.2%
S.ent er i t i di s
0.2%
P.stuar t i i
0. 2%
P.r et tger i
0. 2%
K.pneumoni ae
11. 3%
Pseudomonas sp.
17.4%
E.sakazaki i
0.2%
K.oxytoca
0. 2%
C.di ver sus
0.2%
P.vul gar i s
0.3%
M .mor gani i
0.3%
C.f r eundi i
0.7%
E.col i
23.5%
Gram positif25.63%
Gram negatif74.37%
GRAM POSITIF
S.epidermidis29%
S.aureus9%
S.β-haemolyticus
40%
Staphyloco ccus sp0%S.saprophyticu
s22%
Jenis Kuman Menurut Ruang RSUP Fatmawati JakartaJanuari - Desember 2007
Pola Kuman Januari – Juni 2008
Gram pos itif23%
Gram negatif77%
GRAM NEGATIF
E.aer ogenes16.6%
K. pneumoniae13.3%
P. aeruginosa10.9%
Pseudomonassp.8.7%
Alcaligenessp.0.1%
E. sakazakii
0.3%Prot eusvulgar is
0.3%
E.coli, ent eropat hogenic
0.3%
S. Typhi0.4%
E. agglomer ans0.4%
S. marcescens
7.5%
E.coli
21.4%
P. mirabilis
4.0%
S. liquef aciens
3.8%
E. gergoviae2.8%
E. cloacae
2.6%S. rubidaea
2.6%
K. ozaenae
1.3%
P. Alcalif ac iens0.6%
C. f reundi i
1.0%
C. diversus
0.6%
P. f luorescens
0.4%
GRAM POSITIF
S. epi der mi di s
43%
S. aur eus
6%
S. beta-haem. Gr oup A
0%
S. non-haemol yt i c (gamma)
3%
S. beta-haemol yt i c
28%
S. sapr ophyt i cus
20%
Jenis Kuman Menurut Bahan RSUP Fatmawati JakartaJanuari - Desember 2008
Jenis Kuman Menurut Ruang RSUP Fatmawati JakartaJanuari - Desember 2008
INDIKATOR Hospital Epidemiology Infection Control 2nd ed. (Mayhall. 2001)IADP : 6%
INDIKATOR Hospital Epidemiology Infection Control 2nd ed. (Mayhall. 2001)Phlebitis : 5%
INDIKATOR Hospital Epidemiology Infection Control 2nd ed. (Mayhall. 2001)ISK : 25%
INDIKATOR Hospital Epidemiology Infection Control 2nd ed. (Mayhall. 2001)ILO : 12 %
INDIKATOR Hospital Epidemiology Infection Control 2nd ed. (Mayhall. 2001)VAP : 50%
3003SefalosporinCeftum
1001SefalosporinLacedim
224018SefalosporinCeftazidin
6 Guns
280028SefalusponinMeiact
134284066KuinolonCiprofloxacin
440440SefalosporinCefotaxim
224736487SefalosporinCertriaxone
JumlahLantai 6Lantai 5Lantai 4Golongan
Sistem satu pintu obat,Penggunaan seleksi obat
antibiotika dan biaya obat
Form:ClinicalPathwaysofPneumonia
Variances
ANTIBIOTIC DRUGS
70 %
Cephalosporin 16%Amoxycillin 14%
Peningkatan SDMSub Komite Pengendalian InfeksiKomite Medik RSUP Fatmawati
6 orangCertificate of Achievement dari Asia Pacific Society of Infection Control
1. Dr. Pratiwi Andayani, Sp.A2. Dr. Sjafruddin, Sp.THT3. Dra. DebbieDaniel, Apt, M.Epid.4. Zr. Salfitriawati Arwan, SKep5. Zr. Minarni, AMK6. Zr. Ni Nyoman Sriadi
Langkah BerikutnyaKomite Medik
RSUP Fatmawati
PENGEMBANGANWORLD CLASS HOSPITALS
Dr. Dody Firmanda, Sp.A, MAKetua Komite Medik
RSUP FatmawatiJakarta
world-classadj. (of a person, thing, or activity) of or among the best in theworld.
hos·pi·taln. 1. an institution providing medical and surgical treatment and
nursing care for sick or injured people.2. hist. a hospice, esp. one run by the Knights Hospitallers.
© The Oxford Pocket Dictionary of Current English 2008, originallypublished by Oxford University Press 2008
WORLD CLASS HOSPITALS
DEFINITION(S)
WHO Europe : Performance Assessment Tools for Hospitals
(PATH)
Model Komite Medik RSUP Fatmawati
ClinicalPathways
dengan
PATH
Semoga Bermanfaat
Jakarta, 7 November 2008dodyfirmanda
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